Provider Demographics
NPI:1356674519
Name:YOUNG, KIM SAMUEL (DO)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:SAMUEL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 2267
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504-2267
Mailing Address - Country:US
Mailing Address - Phone:059-825-5655
Mailing Address - Fax:505-992-4990
Practice Address - Street 1:6349 US HWY 550
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NM
Practice Address - Zip Code:87013-0638
Practice Address - Country:US
Practice Address - Phone:575-289-3291
Practice Address - Fax:505-722-7470
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK4023207Q00000X
NMA-1267-04207Q00000X
CODR.0031167207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine